| Objective:To investigate the relevance between tPSA,f/tPSA,PSAD,TRUS,MRI and the positive rate of prostate biopsy.Establish the prediction model of PCa in order to improve accuracy of prostate biopsy.Methods: Clinical data of 840 patients who did prostate biopsy were analyzed retrospectively.To contrast the discrimination in general condition,tPSA,f/tPSA,PSAD,TRUS,MRI by sensitivity,specificity and accuracy,etc.Discuss the difference of positive rate in different tPSA range and expand the “gray zone” from 4~10ng/ml to 4~20ng/ml.Evaluate the diagnostic capability of the Series of Serum PSA?TRUS?MRI and establish the prediction model of patients by Logistic regression.Results: Age of the patients ranges from 43 to 92,the average was(71±8.53),348 patients were confirmed as prostate cancer by pathology,the overall positive rate was 41.4%.The sensitivity,specificity and accuracy of tPSA,f/tPSA,PSAD,TRUS,MRI was 78.89%,49.48%,52.33%;74.55%,44.81%,28.87%;58.62%,26.67%,41.46%;79.17%,47.25%,51.65%.When tPSA < 4ng/ml,4~10ng/ml,10~20ng/ml,? 20ng/ml,the positive rate was 6.72%,24.00%,27.60%,70.99%.When PSA ranges from 4 to 20ng/ml,there were a significant difference in f/tPSA & PSAD between patients with or without prostate cancer,AUC of which was 0.625,0.718.PSAD was more accurate then f/tPSA.Adopt 2/3 of the complete case in data to establish the prediction model and then use the other 1/3 to verify the model using ROC curve.From the comparison of AUC among the prediction model,PSA,f/tPSA and PSAD,the prediction model had the advantage of diagnosis efficiency.Conclusions: When tPSA ranges from 10~20ng/ml,the positive rate was low and had no significant difference between the traditional “gray zone” of PSA,so the “gray zone” of PSA can expand from 4~10ng/ml to 4~20ng/ml.When PSA is the new “gray zone”,the prediction model and f/tPSA,PSAD has great significance to improve the positive rate and accuracy of prostate biopsy. |
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